The Value of Targeted Screening for Glaucoma: The University of Ilorin Teaching Hospital Experience.

BACKGROUND: Glaucoma is an irreversible silent and dangerous eye condition that leads to damage of the optic nerve head. This study aimed to determine the outcome of targeted glaucoma outreaches done in the University of Ilorin Teaching Hospital over three years with a view to early detection and timely institution of management. METHODS: The study is a retrospective review of 3 targeted hospital-based glaucoma screenings, World Sight Day of 2019 (140 participants), World Glaucoma Week of 2020 (176 participants), and World Glaucoma Week of 2022 (183 participants). The criteria for diagnosing glaucoma and glaucoma suspects were taken from the national study of prevalence and types of glaucoma from the Nigerian national blindness survey and International Society for Geographical and Epidemiological Ophthalmology criteria. RESULTS: The study population had a mean age of 45.54 years (SD 16.92) with individuals within the age group of 51-60 years comprising the majority of the participants (26.4%). Most participants had normal vision or mild visual impairment in the right eye (411, 86.1%) and left eye (405, 84.9%) while blindness was recorded in the right eye of 37 (7.7%) participants and left eye of 36 (7.5%). The prevalence of glaucoma cases and suspects among study participants was 29.4% and 42.5%, respectively. There was a statistically significant relationship between the diagnosis of glaucoma and older age, family history of glaucoma and elevated intraocular pressure. CONCLUSION: This study showed that targeted screening for glaucoma is an invaluable tool for ensuring early detection of the disease.

CONTEXTE: Le glaucome est une affection oculaire silencieuse et dangereuse qui entraîne des dommages au nerf optique. Cette étude visait à déterminer les résultats des campagnes de dépistage ciblé du glaucome menées à l'Hôpital universitaire d'Ilorin sur trois ans en vue d'un dépistage précoce et d'une institution rapide de la prise en charge. MÉTHODES: Cette étude est une revue rétrospective de trois dépistages hospitaliers ciblés du glaucome : la Journée mondiale de la vue de 2019 (140 participants), la Semaine mondiale du glaucome de 2020 (176 participants) et la Semaine mondiale du glaucome de 2022 (183 participants). Les critères de diagnostic du glaucome et des suspects de glaucome ont été tirés de l'étude nationale sur la prévalence et les types de glaucome de l'enquête nationale nigériane sur la cécité et des critères de la Société internationale de géographie et d'épidémiologie ophtalmologique. RÉSULTATS: La population étudiée avait un âge moyen de 45,54 ans (SD 16,92), les personnes âgées de 51 à 60 ans constituant la majorité des participants (26,4 %). La plupart des participants avaient une vision normale ou une légère déficience visuelle à l'œil droit (411, 86,1 %) et à l'œil gauche (405, 84,9 %), tandis que la cécité a été enregistrée à l'œil droit de 37 participants (7,7 %) et à l'œil gauche de 36 (7,5 %). La prévalence des cas de glaucome et des suspects de glaucome parmi les participants à l'étude était respectivement de 29,4 % et de 42,5 %. Il existait une relation statistiquement significative entre le diagnostic de glaucome et l'âge avancé, les antécédents familiaux de glaucome et l'élévation de la pression intraoculaire. CONCLUSION: Cette étude a montré que le dépistage ciblé du glaucome est un outil précieux pour assurer la détection précoce de la maladie. MOTS CLÉS: Dépistage du glaucome, Prévalence du glaucome, Cécité due au glaucome, Antécédents familiaux de glaucome.

Prevalence of Mental Ill-Health among Visually Impaired Patients in a Tertiary Institution in Southwestern Nigeria.

BACKGROUND: To study the mental health status of patients with visual impairment in a tertiary institution in Southwestern Nigeria. OBJECTIVES: To determine the mental health status of individuals with loss of vision in Ogbomoso and associated factors. METHODOLOGY: A descriptive cross-sectional study. Questionnaires were administered to obtain information on the socio-demographic characteristics and mental health status. Test for association was done. A total score greater than or equal to 4 out of the 28 items of the General Health Questionnaire was considered a case of mental ill-health. RESULTS: 250 subjects were studied, out of which 126 (50%) were found to have mental ill-health. Statistically significant association was found between age, level of education, occupation, duration of loss of vision, and pattern of loss of vision (p-values < 0.001, 0.020, 0.001, and 0.001 respectively) in bivariate analysis, however, age and pattern of vision loss were not significantly associated with loss of vision in multivariate analysis. Those who lost their vision less than two years from the time of the study had a higher risk of mental health morbidity. Those with sudden vision loss were 3.48 times more likely to have mental health morbidity in bivariate analysis, compared with those with progressive visual loss. CONCLUSION: The prevalence of mental ill-health among people with vision loss is high. Associated factors included level of education, occupation and duration of loss of vision. Predictors of good mental health included younger age group, higher level of education, being employed, longer duration of loss of vision and progressive pattern of vision loss.

CONTEXTE: Étudier l'état de santé mentale des patients atteints de déficience visuelle dans un établissement tertiaire du sud-ouest du Nigeria. OBJECTIFS: Déterminer l'état de santé mentale des personnes souffrant d'une perte de vision à Ogbomoso et les facteurs associés. MÉTHODOLOGIE: Étude descriptive transversale. Des questionnaires ont été administrés pour obtenir des informations sur les caractéristiques sociodémographiques et l'état de santé mentale. Un test d'association a été effectué. Un score total supérieur ou égal à 4 sur les 28 items du General Health Questionnaire a été considéré comme un cas de mauvaise santé mentale. RÉSULTATS: 250 sujets ont été étudiés, dont 126 (50 %) présentaient une mauvaise santé mentale. Une association statistiquement significative a été trouvée entre l'âge, le niveau d'éducation, la profession, la durée de la perte de vision et le type de perte de vision (valeurs p < 0,001, 0,020, 0,001 et 0,001 respectivement) dans l'analyse bivariée, cependant, l'âge et le type de perte de vision n'étaient pas significativement associés à la perte de vision dans l'analyse multivariée. Les personnes ayant perdu la vue moins de deux ans après le début de l'étude présentaient un risque plus élevé de morbidité mentale. Les personnes ayant subi une perte soudaine de la vue étaient 3,48 fois plus susceptibles de souffrir de morbidité mentale dans l'analyse bivariée, par rapport à celles ayant subi une perte progressive de la vue. CONCLUSION: La prévalence de la mauvaise santé mentale chez les personnes souffrant d'une perte de vision est élevée. Les facteurs associés sont le niveau d'éducation, la profession et la durée de la perte de vision. Les facteurs prédictifs d'une bonne santé mentale sont le groupe d'âge le plus jeune, le niveau d'éducation le plus élevé, le fait d'avoir un emploi, la durée la plus longue de la perte de vision et le modèle progressif de la perte de vision. Mots-clés: Déficience visuelle, Mauvaise santé mentale.

Diabetic retinopathy in a Nigerian community.

INTRODUCTION: This study was designed to determine the prevalence of diabetic retinopathy among diabetic patients attending the medical outpatient department of the Federal Medical Centre, Owo, Ondo State, Nigeria. METHODS: This study was conducted between November 2007 and February 2008. Ethical clearance was obtained from the ethical committee of the hospital prior to carrying out the study. 100 diabetic patients selected by simple random sampling were interviewed with the aid of a semi-structured questionnaire. All the respondents had fundoscopy conducted at the eye clinic with the aid of a direct ophthalmoscope. The data was collated and analysed. RESULTS: The majority of the respondents (85 percent) had type 2 diabetes mellitus, while the rest (15 percent) had type 1 diabetes mellitus. 15 percent of the respondents had varying degrees of diabetic retinopathy. The duration of diabetes mellitus was significantly associated with the development of diabetic retinopathy at a p-value of 0.002. CONCLUSION: A few of the respondents had diabetic retinopathy. There is a need to create awareness among diabetic patients on the need for routine ocular examinations.

Visual function survey of commercial intercity vehicle drivers in Ilorin, Nigeria.

OBJECTIVE: To determine the prevalence of visual impairment among commercial intercity vehicle drivers (CIVDs) in Ilorin, Nigeria. DESIGN: A cross-sectional descriptive study. PARTICIPANTS: Among the estimated 450 drivers operating in 5 motor parks for CIVDs in Ilorin, 399 drivers participated in the study. METHODS: A structured questionnaire was administered at the motor parks to consecutive and consenting drivers, and basic ocular examinations were done. RESULTS: Using the Federal Road Safety Commission's requirement for commercial drivers in Nigeria, the prevalence of drivers with inadequate visual acuity (VA) was determined to be 11.5%, and 3.3% had monocular blindness. The prevalence of abnormal colour vision and visual field loss was 4.3% and 5.5%, respectively. There was no statistically significant relationship between visual impairment (VA and visual fields) and involvement in road traffic accidents (p > 0.05). Uncorrected refractive error, cataract, and glaucoma were the commonest causes of visual defects. Three hundred thirty-seven drivers (84.5%) did not have their eyes tested at first licensing and 370 drivers (92.7%) did not have testing at least once during renewals. CONCLUSIONS: A significant number of CIVDs in Ilorin are operating with VA that is far below the expected for their class of licence, and another unacceptably high percentage did not undergo any form of ocular examination prior to obtaining their driving licence. There is a need for renewed efforts to enforce a compulsory basic ocular examination for all prospective commercial drivers, and to ensure that the visual requirement for driving is met.

Conjunctival Kaposi's sarcoma in HIV-positive heterosexual Nigerian woman--a case report.

BACKGROUND: Neoplastic conditions are increasingly been encountered in HIV/AIDS patients. Till date only two cases of conjunctiva Kaposi sarcoma (KS) have been reported in the background of HIV and both in males. OBJECTIVE: To present a 27-year-old African woman with histologically proven conjunctival KS and marked CD4+ cell depletion and to reinforce the fact that KS is an important differential of conjunctival tumour especially in the background of immunosupression in Africa. METHODS: A 27-year-old housewife, presented to the hospital with a three-month history of a rapidly growing tumour attached to the right upper eyelid, cough and weight loss. Patient was given full workup including x-rays, HIV status determination and histological assessment. RESULTS: She was markedly wasted, with widespread pruritic papular skin lesion, and florid oropharyngeal candidiasis. Clinical and chest x-ray findings were suggestive of bilateral lower lobar pneumonia. Screening and confirmatory tests were positive for human immunodeficiency virus (HIV) with CD4+ lymphocyte cell count of 120 cells/ml. Histologic report of the biopsy revealed the mass to be a conjunctival KS. Patient was subsequently commenced on antibiotics and antiretroviral combination therapy. The mass had regressed in size considerably along with improvement in her clinical condition at six months review. She is still being followed up at the medical clinic. CONCLUSION: This is the first reported case of conjunctival KS in an HIV positive African woman. KS should be considered as a possible differential of conjunctiva mass, especially if the patient is HIV positive irrespective of patient's gender.

Medical students' perspectives of blindness, deafness, and deafblindness.

PURPOSE: Blindness and deafness are important, and possibly, the least redeemable deficits. This study assessed the perspectives of final year medical students, who had gone through two months Ophthalmology and Otorhinolaryngology clinical postings, regarding these special groups of individuals. METHODS: A pre-tested structured questionnaire was used to collect information on respondents' demographic characteristics and their perception towards people with hearing and visual handicap. RESULTS: Almost 60% considered blindness worse than deafness while only about 6% considered deafness worse. Blindness (29.8%), deaf/blindness (26.1%), mental retardation (15.5%), and quadriplegia (14.3%) were the main handicaps regarded as worst. Only 4(2.5%) thought deafness was the worst handicap. A much greater proportion (53 - 61%) considered blindness had a greater effect on education, social interaction, family relationships, and overall potential development than deafness (6 - 20%). The majority, 80%, knew a blind person who was famous, 29% a deaf person who was famous, and only 14% a deafblind person who was famous. On a three-point grading, 70% had a moderate attitude as to how their life would be different if they were blind, deaf, or deafblind. Only 56.9% responded to this question. CONCLUSION: The students viewed blindness as a far worse disability than deafness; and consider that deaf/blindness has an exponential effect.

Sonographic evaluation of ocular trauma in Ilorin, Nigeria.

UNLABELLED: PURPOSE.: Ultrasound (US) evaluation of the eye and orbit has become an essential component of clinical ophthalmology. Requests for its use are frequent in the authors' hospital in spite of the absence of a dedicated eye scanner. The extent to which this has influenced the authors' patient management, especially for those with orbito-ocular trauma, informed the decision to carry out this study. METHODS: A retrospective review of cases of orbito-ocular trauma with media opacities and/or intraocular hemorrhage sent for ultrasonography over a 5-year period (January 1997-December 2001) at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, was carried out. The sonographic diagnosis was reviewed with the management outcomes as found in the patients' records. RESULTS: A total of 71 patients (45 male, 26 female) were included in the study (M:F=1:1.7). The minimum age was 1 1 /2 years and maximum was 70 years. The 11- to 20-year age group was mostly affected by trauma (31%). Retinal detachment (22.5%) was the most common posterior segment lesion diagnosed, followed by vitreous hemorrhage (18.3%) and hyphema (11.3%). Visual acuity improved to between 6/9 and 6/18 in 23 (41.4%) of the 56 injured eyes. CONCLUSIONS: The usefulness of orbito-ocular ultrasonography in ophthalmic trauma management has been demonstrated in this study, especially using nondedicated eye scanners when a dedicated one is unavailable.

The choice of ophthalmology as a career among Nigerian medical interns.

To determine the choice of ophthalmology as a career among Nigerian medical interns, structured questionnaire was administered to a set of medical interns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State in the year 2003. The key information sought included the University attended, duration of undergraduate ophthalmology posting, perception of ophthalmology as a specialty, and the choice of postgraduate specialty in order of preference. Also included were improvements they would like to see in the undergraduate teaching of ophthalmology and whether they support the view that interns should have mandatory clinical rotation in other surgical subspecialties like Ophthalmology and Otorhinolaryngology. Seventy-six interns who graduated from seven Nigerian medical schools participated in the study. Average duration of their undergraduate posting in Ophthalmology was 4 weeks. (SD = 3.327). Fifty (67.6%) considered Ophthalmology as an interesting and important specialty, 6 (8.1%) regarded it as a boring specialty, while 18 (24.3%) considered it as just one specialty in their curriculum. Only 5 (6.6%) of the respondents chose Ophthalmology as first choice career while 16 (21%), 14 (18.4%), 13 (17.1%) and 10 (13.2%) chose Surgery, Paediatrics, Community Health and Obstetrics and Gynaecology respectively. 78% of the respondent suggested that interns should have clinical rotation in surgical subspecialties such as Ophthalmology. Other suggestions offered included the need to increase the duration of undergraduate Ophthalmology posting, provision of audiovisual aids and more equipment like Ophthalmoscope for teaching. The interns considered Ophthalmology posting as an important and interesting specialty even though only a few chose it as their future career. There is therefore an urgent need to improve the undergraduate teaching of Ophthalmology. The Medical and Dental Council of Nigeria (MDCN) should make rotation through Ophthalmology a part of the internship curriculum. These measures may increase the interest of medical students and interns alike in Ophthalmology as a career.

Traditional couching for cataract treatment: a cause of visual impairment.

BACKGROUND: Cataract is the most common cause of blindness both in Nigeria and in the world over. Couching as an ancient method of treatment usually practiced by traditional healer is discouraged and has been abandoned as a result of the attendant complications and also because of the availability of better techniques in the treatment of cataract. STUDY DESIGN: Records of 9 eyes of 6 patients (4 males, 2 females) who presented at the eye clinic of the University of Ilorin Teaching Hospital following traditional treatment of cataract known as couching between April 1999 and December 2001 were reviewed retrospectively. RESULT: The male: female ratio was 2:1. The age range was from 43 years to 80 years. The period between couching and presentation was between 3 months and 10 years. All the patients presented as a result of poor vision in the couched eyes. The complications recorded include glaucoma, optic atrophy and panuveitis. None had previous spectacle correction. Couching was done biocularly in 3 patients and uniocularly in 3 patients. The visual acuity at presentation was less than 3/60 in 8(88.8%) eyes. The patients received treatment, ranging from surgical, medical to optical as indicated. Their visual acuity improved to between 6/36 and 6/18 in 6 (66.6%) eyes, while the remaining 3 (33.3%) eyes remained blind. CONCLUSION: Scientifically proven atrocities performed by those who practice medicine without any medical knowledge often referred to as "traditional doctors" as shown here are reasons enough to discourage such practices as they exist at present.

Intraorbital tuberculosis: a case report.

A 75-year-old woman presented at the eye clinic of the University of llorin Teaching Hospital with swelling of the left eyelids and protrusion of the left eyeball. The swelling was painless. Physical examination revealed no systemic abnormality. An incisional biopsy of the lid swelling revealed tuberculous orbital involvement. She responded well to anti-tuberculosis therapy, with regression of the lid swelling and proptosis. The importance of including intraorbital tuberculosis as a differential of orbital swelling in the environment is emphasised.

Herpes zoster infection and HIV seropositivity among eye patients--University of Ilorin Teaching Hospital experience.

This paper reports cases of Herpes Zoster Ophthalmicus (HZO) seen in 10 Nigerian adults at the Eye clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State, Nigeria, some of whom tested positive to HIV infection using ELISA method with confirmation using the Western blot test. There were 6 female and 4 male patients. Five (50%) of the patients tested positive for HIV. A high index of suspicion should be maintained among Ophthalmologists when confronted with patients with HZO who are healthy looking.

Ophthalmic manifestations of fronto-ethmoidal mucocoeles: a report of five cases.

Fronto-ethmoidal mucocoele is rare and will cause visual impairment and blindness when management is belated. In order to improve the awareness of its ophthalmic manifestations and problems associated with its management we retrospectively analyzed clinical, radiological and histological features in five illustrative cases. They all presented with unilateral supra-orbital swellings and proptosis, antedated by head injury in two cases. Other ophthalmic manifestations included eye lid swelling, progressive visual loss, unilateral ptosis, exotropia and diplopia. Only two patients had nasal symptoms. In all cases, x-rays of the paranasal sinuses revealed radiolucent frontal sinuses with eroded anterior walls, floors and midline septa. Brain scan in one case demonstrated opacification and enlargement of the corresponding sinus. Fronto-ethmoidectomy in four cases confirmed erosion of sinus' walls and floors and in one case of the contiguous supra-orbital ridge in addition to colored fluid aspirates. In all cases, the curetted sinus lining comprised of chronic inflammatory tissue. Surgical intervention was followed by prompt postoperative resolution of ophthalmic manifestations. A high level of suspicion is essential for early diagnosis and treatment of fronto-ethmoidal mucocoeles and will assist in preventing irreversible visual loss.